Maurits Graafland

Systematic review of serious games for medical education and surgical skills training

The application of digital games for training medical professionals is on the rise. So‐called ‘serious’ games form training tools that provide a challenging simulated environment, ideal for future surgical training. Ultimately, serious games are directed at reducing medical error and subsequent healthcare costs. The aim was to review current serious games for training medical professionals and to evaluate the validity testing of such games.

How to Systematically Assess Serious Games Applied to Health Care

The usefulness and effectiveness of specific serious games in the medical domain is often unclear. This is caused by a lack of supporting evidence on validity of individual games, as well as a lack of publicly available information. Moreover, insufficient understanding of design principles among the individuals and institutions that develop or apply a medical serious game compromises their use. This article provides the first consensus-based framework for the assessment of specific medical serious games. The framework provides 62 items in 5 main themes, aimed at assessing a serious game’s rationale, functionality, validity, and data safety. This will allow caregivers and educators to make balanced choices when applying a serious game for healthcare purposes. Furthermore, the framework provides game manufacturers with standards for the development of new, valid serious games.

Systematic review on the effectiveness of augmented reality applications in medical training

AbstractBackgroundComputer-based applications are increasingly used to support the training of medical professionals. Augmented reality applications (ARAs) render an interactive virtual layer on top of reality. The use of ARAs is of real interest to medical education because they blend digital elements with the physical learning environment. This will result in new educational opportunities. The aim of this systematic review is to investigate to which extent augmented reality applications are currently used to validly support medical professionals training.MethodsPubMed, Embase, INSPEC and PsychInfo were searched using predefined inclusion criteria for relevant articles up to August 2015. All study types were considered eligible. Articles concerning AR applications used to train or educate medical professionals were evaluated.ResultsTwenty-seven studies were found relevant, describing a total of seven augmented reality applications. Applications were assigned to three different categories. The first category is directed toward laparoscopic surgical training, the second category toward mixed reality training of neurosurgical procedures and the third category toward training echocardiography. Statistical pooling of data could not be performed due to heterogeneity of study designs. Face-, construct- and concurrent validity was proven for two applications directed at laparoscopic training, face- and construct validity for neurosurgical procedures and face-, content- and construct validity in echocardiography training. In the literature, none of the ARAs completed a full validation process for the purpose of use.ConclusionAugmented reality applications that support blended learning in medical training have gained public and scientific interest. In order to be of value, applications must be able to transfer information to the user. Although promising, the literature to date is lacking to support such evidence.

Training situational awareness to reduce surgical errors in the operating room

Surgical errors result from faulty decision‐making, misperceptions and the application of suboptimal problem‐solving strategies, just as often as they result from technical failure. To date, surgical training curricula have focused mainly on the acquisition of technical skills. The aim of this review was to assess the validity of methods for improving situational awareness in the surgical theatre.

Google Glass in Surgery

As a surgeon you have a unique and best view on the operating field. No resident or intern will experience that same look and feel before being at the wheel themselves. Now, imagine the benefits of seeing through the sur-geon’s eyes in this moment.Today, the implementation of a small camera, a screen, and audio capability in a spectacles’ frame (Google Glass, Google Inc, Mountain View, CA) could do just that and more; direct interaction and extended video recording capabilities will change the way we perform and teach medicine.On October 28, 2013, Dutch surgeon Marlies Schijven successfully communicated with the American surgeon Rafael Grossmann in what is known to be the first glass-to-glass consultation while performing an operation. At the time of operating, Grossmann was in a conference center miles away from Schijven, who was in the Academic Medical Center (Amsterdam, the Netherlands). The con-sultation was followed live at the conference center and worldwide via a broadcast on YouTube.com. It is a proof of concept showing how a surgeon or any other health care professional might consult with fellow specialists. This way, the physical barriers associated with an operating the-atre, different sites within hospitals or countries, or even a faraway battlefield may be quite easily overcome.Not only communication with other people but also the interaction with live information adds value to techni-cal devices such as these glasses. Patients’ charts (eg, incoming lab results, new radiology findings), patient monitoring data (eg, heart rate, oxygenation), equipment warning signs, or augmented reality overlays can be pre-sented to your eye without having to turn away from the patient.Besides direct interaction, the possibilities for video recording are hugely expanded. Current recording equip-ment is often static and intrusive in a clinical setting. Simply wearing a pair of spectacles will surely lower the bar for more frequent use. Yet most interesting are the newly offered points of view, literally. For instance, ask-ing your patient to wear a pair of spectacles gives you “the patient’s look” on yourself. No doubt, this is an invaluable source for feedback of which students and experienced physicians alike could benefit.Continuous recording or only a 30 minutes log (“black box”) are also of interest. When an unexpected situation has occurred during a procedure or consultation, the log can be reviewed and unknown or otherwise overseen rel-evant factors unveiled. An illustrated start for a cycle of improvement. In addition, the recording of these unex-pected situations might aid in legal matters.Admittedly, many of the device’s components and fea-tures are not entirely new on their own. Head mounted displays have been around for many years and hands-free calling is not much out of the ordinary either. Furthermore, head-mounted displays have already been proven to improve information processing by individuals in the operation room and enhance human visual capabilities.

A Multicenter Prospective Cohort Study on Camera Navigation Training for Key User Groups in Minimally Invasive Surgery

Background. Untrained laparoscopic camera assistants in minimally invasive surgery (MIS) may cause suboptimal view of the operating field, thereby increasing risk for errors. Camera navigation is often performed by the least experienced member of the operating team, such as inexperienced surgical residents, operating room nurses, and medical students. The operating room nurses and medical students are currently not included as key user groups in structured laparoscopic training programs. A new virtual reality laparoscopic camera navigation (LCN) module was specifically developed for these key user groups. Methods. This multicenter prospective cohort study assesses face validity and construct validity of the LCN module on the Simendo virtual reality simulator. Face validity was assessed through a questionnaire on resemblance to reality and perceived usability of the instrument among experts and trainees. Construct validity was assessed by comparing scores of groups with different levels of experience on outcome parameters of speed and movement proficiency. Results. The results obtained show uniform and positive evaluation of the LCN module among expert users and trainees, signifying face validity. Experts and intermediate experience groups performed significantly better in task time and camera stability during three repetitions, compared to the less experienced user groups (P < .007). Comparison of learning curves showed significant improvement of proficiency in time and camera stability for all groups during three repetitions (P < .007). Conclusion. The results of this study show face validity and construct validity of the LCN module. The module is suitable for use in training curricula for operating room nurses and novice surgical trainees, aimed at improving team performance in minimally invasive surgery.

A serious game to improve situation awareness in laparoscopic surgery

Safety analyses show that errors in surgery are more frequently caused by misperceptions and misjudgments than from technical failure of the surgeons. The adaptive coupling between humans and their environment, based on the perception and comprehension of signs and signals when performing a complex task, is referred to as situation awareness (SA). To date, no off-site training methods are offered to improve SA in surgical trainees. To aid the improvement of SA in minimally invasive surgery (MIS), a serious game was designed for surgical trainees. This serious game teaches surgical trainees to deal with major and minor problems in the minimallyinvasive surgical theatre that originate outside of the direct line of sight. Serious games are instructional methods that allow serious skills training in a challenging environment. This paper discusses insights on design, development and evaluation of a game-based educational program for surgical residents.

How Serious Games Will Improve Healthcare

Games have the potential to attract large numbers of players and bring to them a specific understanding, skill, or attitude. The classic image of videogaming—socially deprived youngsters killing mystical monsters in their parents’ basement—has evolved into a highly social, everyday activity that attracts all age groups to play games in the family living room. Serious games, therefore, are increasingly recognized as methods to promote health, treat patients, and train healthcare professionals. Whereas the technological developments in software, platforms, and wearable sensors are moving at high speed, the number of potential applications is rising and so is their use. This chapter aims to give an overview of underlying game mechanisms, main healthcare-related purposes, and the evidence supporting their effectiveness. We conclude that although the field is maturing in terms of diversification and evidence, more high-quality trials are needed to gain insight into the effectiveness of individual games as well as methods to improve transparency for individual users and clinicians.